医疗报销比例与居民就医行为——基于CHIP2018的实证分析  

Medical Reimbursement Rate and Residents'Medical Behavior:An Empirical Analysis Based on CHIP2018

作　　者：周慧 吴宇涵 岳希明[2] Zhou Hui;Wu Yuhan;Yue Ximing(Social Sciences in China Press,Beijing 100026,China;School of Finance,Renmin University of China,Beijing 100872,China)

机构地区：[1]中国社会科学院中国社会科学杂志社,100026 [2]中国人民大学财政金融学院,100872

出　　处：《南开经济研究》2024年第1期205-220,共16页Nankai Economic Studies

基　　金：国家社会科学基金重大项目“新时代我国财税再分配的精准调节机制研究”(22&ZD090)的资助。

摘　　要：我国现已基本建立全民医疗保障体系,但医疗报销比例在不同群体之间存在较大差异,制约了个体的医疗消费需求。本文基于CHIP2018数据,使用县级空间加权平均报销比例作为工具变量,采用IV-Heckman、IV-o Probit等方法考察了医疗报销比例对居民就医行为的影响及作用机制。研究发现,提高医疗报销比例有助于释放居民门诊与住院就医需求,进而显著提高了个体医疗消费总支出。异质性分析发现,医疗报销比例的变动对农村居民和低收入群体的就医选择行为促进作用最大,但城镇居民和高收入群体的医疗消费支出增长更多。未来我国医疗保险制度改革需要在提高医疗保险实际报销比例的同时,逐步消除城镇职工基本医疗保险制度与城乡居民基本医疗保险制度之间的系统性差异,从而实现公平适度保障人民群众基本医疗保障权益的目标。China has now basically established a universal medical insurance system,but the large differences in medical reimbursement ratios among different groups still constrain individuals from meeting their medical consumption needs.Based on CHIP2018 data,combing the county-level spatially weighted average reimbursement ratio as instrumental variable,we investigate the impact of medical reimbursement ratio on residents'medical behavior and its mechanism of action using the IV-Heckman and IV-oProbit methods.It was found that increasing medical reimbursement rates helped to release residents'demand for outpatient and inpatient medical care,which in turn significantly increased total individual medical consumption expenditure.Heterogeneity analysis found that changes in medical reimbursement rates have the greatest impact on promoting healthcare-seeking behavior among rural residents and low-income groups,while medical expenditure growth is highest among urban residents and high-income groups.The future reform of China's medical insurance system needs to gradually eliminate the systematic differences for its residents,while increasing the actual reimbursement ratio of medical insurance,so as to achieve the goal of fair and moderate protection of people's basic medical security rights and interests.

关 键 词：医疗报销比例 医疗消费支出 就医行为 工具变量法 

分 类 号：F842.684[经济管理—保险] R197.1[医药卫生—卫生事业管理]